MEDICARE: KERI PARKER MS-CCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	41YS00858900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	T44544327368685	OTHER	NJ	LICENSE

General Provider Information

NPI Number	:	1184153660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERI PARKER MS-CCC

Provider Business Mailing Address
First Line	:	126 STATION RD
Second Line	:
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-2123
Country	:	US
Telephone Number	:	732-691-6221
Fax Number	:

Provider Business Practice Location Address
First Line	:	962 RIVER AVE
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5605
Country	:	US
Telephone Number	:	732-370-8600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2017
Last Update Date	:	11/22/2021

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Directions to “ KERI PARKER MS-CCC” Practice Location

Language	Start Address	Practice Location

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